It develops through the four steps shown in Fig. 3.5b, and it begins with something we do: taking antibiotics when they are not required, or taking an incomplete dose.
- A few bacteria develop resistance to antibiotics. In any large population of bacteria a small number happen to be able to survive the medicine.
- When antibiotics kill the bacteria causing illness, they also kill the good bacteria that protect the body from infection. The space and food that those bacteria were using is now free.
- The antibiotic-resistant bacteria grow and take over. With their competitors removed, the few survivors multiply into the majority.
- Some bacteria transfer antibiotic resistance to other bacteria, causing more problems. Resistance now spreads sideways, to kinds of bacteria that were never treated at all.
Fig. 3.5a adds the routes by which these resistant bacteria then reach everyone else: from antibiotics given to animals into animal food products; from manure and animal faeces into crop fields and so into our digestive system through crop produce; and from patient to patient in hospitals through dirty surfaces and healthcare workers, and then out into the community when patients go home.
The result, as the chapter says, is that bacteria that were earlier killed by a given antibiotic survive and multiply despite treatment — which makes common infections harder to treat and increases the risk of complications, prolonged illness and even death.